Impact of Proton Pump Inhibitor Therapy for GERD on Acute Exacerbations and Pneumonia Risk in Patients with COPD: A Retrospective Cohort Study
Keywords:
Chronic Obstructive Pulmonary Disease, Proton Pump Inhibitors, Gastroesophageal Reflux, PneumoniaAbstract
Background: Chronic obstructive pulmonary disease (COPD) is frequently complicated by gastroesophageal reflux disease (GERD), which may exacerbate respiratory symptoms and increase the risk of acute exacerbations. Proton pump inhibitors (PPIs), commonly prescribed for GERD, have been hypothesized to influence respiratory outcomes in COPD, though evidence remains inconclusive and disease-stage-specific effects are poorly understood. Objective: To evaluate the temporal association between PPI therapy and respiratory outcomes and pneumonia risk in patients with incident and prevalent COPD. Methodology: A retrospective cohort study was conducted using a nationally representative claims database. PPI exposure was categorized into treatment and post-treatment phases. Incidence rate ratios (IRRs) for moderate exacerbations, severe exacerbations, and pneumonia were calculated using Poisson regression models, adjusted for age, sex, comorbidities, and medication history. Results: In incident COPD patients, PPI therapy was associated with a significant reduction in moderate exacerbations during treatment (IRR 0.72; 95% CI: 0.65–0.80) and post-treatment (IRR 0.86; 95% CI: 0.78–0.95). Severe exacerbations declined markedly after therapy cessation (IRR 0.22; 95% CI: 0.14–0.35), while pneumonia risk remained stable during treatment (IRR 1.01) and decreased post-treatment (IRR 0.83). In prevalent COPD patients, no significant changes were observed in moderate or severe exacerbation rates, and pneumonia risk remained unchanged. Conclusion: PPI therapy may offer respiratory benefits in patients with incident COPD, particularly in reducing moderate exacerbations and pneumonia risk, with delayed improvement in severe exacerbations. These findings support the integration of reflux control in early COPD management. In contrast, prevalent COPD patients appear less responsive to acid suppression.References
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